The following is a guest post by Jacqueline Hellen and Lisa Parker of MEASURE Evaluation
While programs in low- and middle-income countries seek to support children living outside traditional households or in adverse situations that expose them to HIV, violence, trafficking, or other risks to their well-being, programs HIV and social service programs in resource-limited countries often miss these children, as they are hard to reach and often mobile. Examples of such children are those living or working in mines or on the street, and children of female sex workers. Programs that do work with them face challenges evaluating well-being outcomes and yet require such information to provide specialized support.
To address this gap, MEASURE Evaluation, funded by USAID and the United States President’s Emergency Plan for AIDS Relief, has developed a suite of survey indicators and tools and a guidance manual to assist these programs to evaluate well-being outcomes. To date, no other tools are widely available for comprehensive well-being outcome measurement designed for these at-risk populations of children and their caregivers.
The Children in Adverse Situations Survey Indicators and Tools and implementation manual are intended for use by government ministries, national child welfare and protection programs, and nongovernmental organizations. These indicators and tools are meant to help countries or organizations to use a holistic set of standardized outcome indicators to assess these child populations, (foster better data sharing within and between countries and programs, and expand the evidence base on these invisible children to better understand their needs.
The project first developed compendiums of indicators based on a literature review, documentation received from key informants working in service delivery organizations, and performance monitoring plans from programs serving these children. From these findings, MEASURE Evaluation consolidated lists of the most commonly used sub-domains and data elements and transformed them into two lists of outcome indicators for children of female sex workers and street children as well as children working in mines. From that point, we created data collection tools to measure the indicators, using measures sourced from validated and internationally recognized questionnaires of similar nature.
MEASURE Evaluation then developed two sets of survey tools, one for outcome measurement of children of female sex workers and the second for outcome measurement of street children and children working in mines. The first set of survey tools includes three questionnaires for children of female sex workers —one for the sex worker caregiver, a second for her child, or children ages 0 to 9, and a third for adolescent children of female sex workers, ages 10 to 17. The second set of survey tools includes two questionnaires for street children and children working in mines — one for children ages 0 to 13 and a second for adolescent children ages 14 to 17.
The questionnaire to measure outcomes among children of female sex workers ages 0 to 9 should be administered to the female caregiver about her child, or children within that age group. The questionnaire to measure outcomes among street children and children working in mines ages 0 to 13 should be administered to the person most knowledgeable about the child who plays a significant role in the child’s life.
The manual specifies that informed consent must be received prior to conducting the survey and that respondents have a right to share and receive information and to maintain their privacy. The manual also stresses that investigators should determine and minimize any potential harm to participants during or as a result of data collection, compilation, or use. It recommends that a child protection policy for researchers should be developed to ensure that staff does not engage in any behavior that may be negatively construed or potentially abusive.
Data analysis and use
The manual reminds researchers that while baseline and endline data can be compared to determine the effect of program interventions on well-being, interventions cannot be definitively attributed using these survey tools unless information is also collected from a comparison group.
Data from surveys can be used to inform strategic planning and resource allocation for program planning and management and to advocate for resources to help children in adverse situations. The manual includes indicators that in-country users can adapt to measure their program outcomes, plus a few other indicators that cannot be adapted but still may provide important demographic or contextual information that can help with interpretation of the findings.
For more information: Jacqueline Hellen, MPH is senior health associate and Lisa Parker, PhD is senior technical advisor for measurement and learning at MEASURE Evaluation, Palladium. For more information on MEASURE Evaluation’s work on children in adverse situations, see https://www.measureevaluation.org/our-work/youth-and-adolescents/alternative-care
 These sources included the Centers for Disease Control violence against children surveys (VACS), ICAP Population-based HIV Impact Assessment (PHIA), and the Integrated HIV Bio-behavioral Surveillance (IBBS) Toolbox, among others.
Feature photo credit: Copyright 2019 by Larry C. Price/Price and Price Creative LLC.